Presentation on ITP By James Runco

1. Presentation on ITP By James Runco “Everyone bleeds sometimes, I just bleed more.”

2. ITP ITP stands for Idiopathic Thrombocytopenic Purpura but it is also frequently called: Immune Thrombocytopenic Purpura or Idiopathic Thrombocytopenia

3. Background Information There are three Basic types of blood cells made in the marrow of the bones each with their own specialized jobs. Red Blood Cells (Rbc’s) Carry Oxygen White Blood Cells (Wbc’s) Protect your body from infection Platelets (Plt’s) Help your help your body to heal injuries

4. This is a Picture of Normal Blood Cells

5. What ITP does. ITP is an autoimmune disease during which your body’s immune system attacks and destroys your platelets. The body releases auto-antibodies which chemically tag its’ own cells as foreign White blood cells then seek out and destroy platelets as if they were fighting an infection This causes a rapid drop in the level of platelets in a person’s body

6. More about ITP This Thrombocytopenia (lowered platelet level) is Idiopathic, (without known cause) and can be triggered at any time. Platelets are a specialized form of blood cells that are absolutely essential for your blood to clot. When they are attacked by the White Blood cells it can be disastrous. Your body is left unable to mend any cuts or stop bleeding even from the smallest internal injuries

7. Symptoms of ITP • Excessive bleeding with minor injuries • Spontaneous bleeding from the mouth and nose • Unexplainable or spontaneous bruising • Excessive internal bleeding • Disturbed sleep cycle/ Insomnia • Irregular appetite • Depression

8. Depression and ITP ITP is accompanied by short term or more permanent depression. This is because 2% of the body’s serotonin is stored in the platelets; when the platelets are destroyed so is this mood elevating neurotransmitter. Platelets also carry Serotonin’s “parent” chemical called L-Tryptophan

9. Depression and ITP Continued This L-Tryptophan is able to pass through the blood brain barrier, so it’s loss is the probable cause of the sleep/ eating irregularities.

10. This is Jane

11. Normal Platelet Counts

12. Thrombocytopenic Platelet Counts

13. This is Jane with ITP

14. Causes The exact causes of ITP are as yet unknown, but there is currently research going on to try and determine what causes this disease. There are many theories, most state that ITP is a multifactorial disease with a strong genetic predisposition. Researchers are currently looking for multiple instances of ITP in a family, and have found that in some cases ITP can be passed from mother to child.

15. Moms and ITP There seems to be a connection between ITP and pregnancy. A previously normal woman can sometimes develop ITP during a pregnancy. Pregnancies are much more dangerous for women with ITP, both because their platelet counts can drop and because of the bleeding involved with delivery.

16. Theories Three most common theories for ITP are: • The Microbial Trigger Theory • The Molecular Mimicry Theory and • The Free Radical Damage Theory

17. The Microbial Trigger Theory • Links the destruction of platelets to a chemical called interleuken 12 that is released when the body is fighting a bacterial infection • They believe that in some people this interleuken 12 can inadvertently activate dormant self reactive cells that then convince your body that a cell near the bacteria is also part of the infection • If that cell is a specialized platelet then you would develop ITP

18. The Molecular Mimicry Theory • This theory says that someone can develop ITP when the bodies T helper cells recognize a viral or bacteria amino acid sequence that happens to occur on the surface of a platelet • Normally T helpers that would target somatic cells are inhibited by other immune agents. • If there is a malfunction in the production of these inhibiting agents then the self reactive T helper cells are free to target platelets for destruction

19. Free Radical Damage Theory • DNA is damaged by “free radicals” • Free radicals are compounds that build up in the body, which need electrons in order to become stable • If they steal these electrons from DNA they can cause mutations which could effect the immunes system, and possibly trigger ITP or other Autoimmune diseases.

20. Diagnosis ITP is often the Diagnosed by its’ symptoms. It is frequently the diagnosis when all other blood diseases are ruled out and there seems to be the body mounting an attack against the platelets There are different forms of ITP. Some children experience a disease which is listed as ITP because it is thrombocytopenia with an unknown origin. However it differs from adult and chronic childhood ITP because many of these childhood cases last only a matter of months and then go into permanent remission.

21. ITP Statistics • “Approximately 200,000 people in the US have ITP” • In Adults women are three times more likely to have ITP than men, but in children the statistics are fairly even • “The percentage rate of ITP cases is increasing. Each year there are approximately 20,000 new cases or about 10 to 125 per million people.”

22. Treatment In most cases ITP is not fatal and can be treated. There is a wide variety of treatment options, but with only partial success due to the unknown nature of the disease. The most commonly excepted, and most successful treatments for ITP involve the removal of the spleen because it is a site for autoantibody production. People are also very commonly given Prednisone which is an artificial steroid which can enhance platelet production For emergency case treatment (normally when platelets get below 20,000) They will administer IV G or intravenous gammaglobulin for several days, and they wait for counts to rebound

23. Sources Platelet Disorder Support Association www.ITPpeople.com Scripps Institute website http://seconde.scripps.edu/ltp Family Genetics.net www.familygenetics.net